HeartDrug Research Laboratories, Johns Hopkins University Towson, 7600 Osler Drive, Towson, MD 21204, USA.
Eur Heart J. 2010 Jan;31(2):227-35. doi: 10.1093/eurheartj/ehp434. Epub 2009 Oct 23.
To correlate inhibition of platelet aggregation (IPA) with bleeding events assessed by TIMI, GUSTO, and BleedScore scales in a large cohort of patients with coronary artery disease (CAD) and ischaemic stroke (IS) treated with chronic low-dose aspirin plus clopidogrel. Data from recent trials and registries suggest a link between increased risk of bleeding and cardiovascular mortality. However, the potential association of bleeding risk and IPA is not established. It may play a critical role for the safety of more aggressive platelet inhibition or/and individual tailoring of antiplatelet strategies.
Secondary post hoc analyses of 5 microM ADP-induced IPA and bleeding complications assessed by TIMI, GUSTO, and BleedScore scales in a combined data set consisting of patients with documented CAD (n = 246) and previous IS (n = 117). Demographic characteristics differ substantially depending on the underlying vascular disease; however, IPA and bleeding risks were similar between CAD and IS. All three bleeding scales adequately captured serious haemorrhagic events, where the TIMI scale was the most exclusive, whereas BleedScore was the most inclusive. Over half of all patients experienced superficial event(s), most commonly occurring during two to three distinct bleeding episodes. There was no correlation between IPA and duration of antiplatelet therapy. Inhibition of platelet aggregation >50% strongly correlates with minor (r(2) = 0.58, P < 0.001; c-statistic = 0.92), but not severe (r(2) = 0.11, P = 0.038; c-statistic = 0.57), bleeding events.
Chronic oral combination antiplatelet regimens are associated with a very high (56.5-60.7%) prevalence of superficial bleeding episodes, which are grossly underestimated in trials and registries. The role of such frequent mild complications for the overall benefit of antiplatelet therapy is entirely unknown, as is their effect on compliance. Although IPA is well suited for defining the risk of minor complications, prediction of more severe bleeding events may be challenging.
在接受慢性低剂量阿司匹林加氯吡格雷治疗的冠心病（CAD）和缺血性卒中（IS）大患者队列中，将血小板聚集抑制（IPA）与 TIMI、GUSTO 和 BleedScore 量表评估的出血事件相关联。最近的试验和登记数据表明，出血风险增加与心血管死亡率之间存在关联。然而，尚未确定出血风险与 IPA 之间的潜在关联。对于更积极的血小板抑制或/和个体化抗血小板策略的调整，它可能发挥关键作用。
对包含已确诊 CAD（n=246）和既往 IS（n=117）患者的合并数据集，使用 5 μM ADP 诱导的 IPA 和 TIMI、GUSTO 和 BleedScore 量表评估的出血并发症进行了二次事后分析。根据潜在的血管疾病，患者的人口统计学特征存在明显差异；然而，CAD 和 IS 之间的 IPA 和出血风险相似。所有三种出血量表都充分捕获了严重的出血事件，其中 TIMI 量表最具排他性，而 BleedScore 量表最具包容性。超过一半的患者经历了轻微的事件，最常见的是在两到三个不同的出血事件中发生。IPA 与抗血小板治疗的持续时间之间没有相关性。血小板聚集抑制>50%与轻微出血事件强烈相关（r²=0.58，P<0.001；c 统计量=0.92），但与严重出血事件无关（r²=0.11，P=0.038；c 统计量=0.57）。
慢性口服联合抗血小板方案与非常高（56.5-60.7%）的轻微出血事件发生率相关，而这些事件在试验和登记中被严重低估。对于抗血小板治疗的整体获益，此类频繁的轻度并发症的作用完全未知，其对依从性的影响也未知。虽然 IPA 非常适合定义轻微并发症的风险，但预测更严重的出血事件可能具有挑战性。
